Provider Demographics
NPI:1164653846
Name:BURKHART, ELIZABETH LORAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LORAYNE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LORAYNE
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2909 S TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2937
Mailing Address - Country:US
Mailing Address - Phone:405-799-7510
Mailing Address - Fax:405-799-4742
Practice Address - Street 1:2909 S TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2937
Practice Address - Country:US
Practice Address - Phone:405-799-7510
Practice Address - Fax:405-799-4742
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist